How wealth affects health

Almost 60% of five-year-olds in some of Britain’s poorest areas do not reach a “good level” of behaviour and understanding—double that found in wealthier suburban parts of England, a review into Britain’s widening social and health inequalities says.

Stark inequalities in children’s development between local authorities are revealed by data published by Sir Michael Marmot, professor of epidemiology and public health at University College London, who last year produced a landmark government review into how wealth affects health. The key determinants of health, he argues, relate to a host of issues including employment, the welfare state and child development.

His new report showed that 44% of all five-year-olds in England are considered by their teachers to be falling behind in their development.

However, in richer commuter towns such as Solihull in the English midlands and Richmond upon Thames, west London, state-funded schools report this figure to be about 30%.
In Haringey, a deprived part of north London, it is almost double. Marmot, a public health specialist and author of Fair Society, Healthy Lives, said: “The evidence is very clear: investing in pre-school years pays most dividends. We already know that, by the age of 10, a child from a poorer background will have lost any advantage of intelligence indicated at 22 months, whereas a child from an affluent family will have improved his or her cognitive scores purely because of his/her advantaged background.”

He pointed out that “education and child development are key for health. It is the educated who stop smoking ... we know the key driver of teenage pregnancy is not getting early child development. You are not going to get pregnant as a teenager if you develop as a child.”

Only two dozen municipal authorities of the 150 surveyed could claim to have more than half their five-year-olds passing the educational standard set by the government.

Marmot said he was concerned that the government was just focusing on the “poorest” in society—the middle stratum of society needed help, too.

“I have tried to have this conversation with government without much success,” he said, adding that “cuts to Sure Start (for children) and children’s centres won’t help”.

There was also an alarming health gap opening up within areas. Marmot pointed out that, in the London borough of Westminster, the average life expectancy of male residents was 83, five years longer than the English norm, but this masked wide disparities. The poorest in the borough could expect to live 17 years less than the richest.

Not only has life expectancy linked to social standing, so has the time spent in good health. The review showed that the Wirral, in north-west England, had the biggest difference in “disability-free life expectancy” between those at the top and those at the bottom of the economic ladder, with wealthy people likely to live 20 years longer without physical impairment.

The data is meant to inform ministers as the government has proposed taking public health out of the UK’s state-funded National Health Service (NHS) and put under the control of local government.
However, it is likely to come under pressure as budgets are squeezed. Marmot pointed out that the city council in Birmingham, in central England, a conurbation with large areas of poverty, had successfully raised the number of five-year-olds attaining a good level of behaviour and understanding from 38% to 55% in five years.

However Jim McManus, Birmingham’s joint director of public health, said that the “single most effective measure to deal with inequalities had been about £50-million spent to improve social housing in the city ... We know it’s a new financial environment and that’s quite a challenge.”

Others warned the government’s plan would turn the clock back. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said: “It’s important to learn the lessons of history.

“Public health was taken out of local [government] control in 1974 and it was the best thing that ever happened to it.

“Why put it back? The new plans provide no clue as to whether there will be enough public health funds available and will see councillors who were elected on a platform of schools and the environment suddenly responsible for health.”—